Job description
Seeking qualified Licensed Registered Nurse with strong clinical nursing skills to manage a case management team of social workers and registered nurses.
Actively participates in clinical performance improvement activities. Collaborates and communicates with interdisciplinary team in all phases of discharge and care planning process. Communicates effectively with patients, family, medical staff, care team members, students, supervisors and outside contacts. Evaluates the process of initiating plans for discharge and/or transitions of care, and ongoing case management needs for patient and/or family. Oversees the implementation of appropriate plans to attain desired outcomes within projected time frames. Manages team's goals and time frames. Manages, supervises and facilitates development of staff and oversees the day-to-day tasks/activities in the department. Supervises all aspects of discharge planning and/or care coordination for assigned team members. Supervises staff on the coordination and facilitation of patient care progression throughout the continuum. Works collaboratively and maintains active communication with physicians, nursing and other members of the interdisciplinary care team to effect timely, appropriate patient management.
Job Responsibilities
- Participates in monthly reporting of trends and outcomes that identifies patient / client populations at program meetings and management operational meetings.
- Analyzes patient outcomes and program trends viewing the big picture through an inter-disciplinary approach
- Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization.
- Ensures staff provides clear and appropriate documentation for complex patients with regards to plan of care and patient progress towards reaching outcomes.
- Participates in monthly outcomes reporting of client/patient based data to client/patient based teams, or other agent as appropriate, in order to improve quality of case management services.
- Supports the contact of families, physicians or other healthcare team members in anticipation of specials needs of the patients or family in a timely manner to facilitate effective treatment plans as evidenced by observation, chart review and team feedback.
- Provides educational materials and methods in support of team member's ability to document appropriate to the patient's level of understanding and motivation as evidenced by chart review, observation and team feedback.
- Audit team's demonstration of family/caregiver education and training as appropriate as evidenced by observation and documentation.
- Demonstrates collaboration in communication with team members and is open to feedback and receptive to change as evidenced by team feedback.
- Gives appropriate instruction and supervision to assistive personnel consistent with program and regulatory requirements.
- Utilizes advanced conflict resolution skills as necessary to insure timely resolution of issues.
- Works collaboratively and maintains active communication with physicians, nursing, therapy and other members of the interdisciplinary team to effect timely and appropriate patient management.
- Consistently identifies, and works with staff to identify, clinical variables affecting patient outcomes.
- Educates staff on variances in patient responses and how to proactively adjust the care plan in coordination with the interdisciplinary team. Provides oversight of staff to increase knowledge and understanding of the clients diagnosis, prognosis, care needs, and cost/barriers to goal achievement. Review staff's written plan of care/ documentation reflects appropriate actions to meet expected outcomes.
- Demonstrates ability to evaluate and communicate appropriate criteria to payors to ensure appropriate level of reimbursement.
- Demonstrates operational use of criteria for continued stay and admissions reporting if in an acute setting.
- Leads education supporting team member's ability to communicate with payers to facilitate reimbursement for assigned patients.
- Discusses payer criteria and issues with clinical team and works to resolve problems with payers as needed Works with staff to coordinate patient needs and actively engaging the care team to maximize patient and family in discharge planning, care transitions and ongoing case management. Works with staff to facilitate family meetings with all patients as requested by patient, family or team.
- Monitor and report length of stay and ancillary resource use on an ongoing basis.
- Supports actions to achieve continuous improvement in both areas.
- Leads collaboration with physician and members of the interdisciplinary team to facilitate care for designated case load.
- Monitors patient's progress, intervening as necessary and appropriate to insure the plan of care and services provided are patient focused, high quality, efficient and cost effective.
- Facilitates the following actions on a timely basis: completion of treatment plan and discharge plan, modification of plan of care, as necessary, to meet the ongoing needs of the patient, communicate to payers and other relevant information to the care team, and completion of all required documentation in EMR's and data management systems.
- Manages, supervises and facilitates development of staff
- Participates in the interviewing/hiring process by reviewing job profiles, reviewing candidate application and resumes, developing behavioral interview questions, conducting and evaluating interviews in a timely fashion, and providing feedback/recommendation in hiring decision. Acknowledges and provides reward / recognition to staff and/or team members. Insures compliance with mandatory activities (orientation, reorientation, compliance, etc.) and prepares staff for regulatory surveys.
- Completes employee performance appraisal by stated deadline 100% of the time.
- Provides ongoing individual coaching as evidenced by documentation, observation, and team feedback Identifies staff education needs and facilitates the educational process as evidenced by in-services and staff feedback
- Plans and updates in-service education programs for all case management staff annually.
- Supervises all aspects of discharge planning and/or care coordination for assigned team members.
- Ensures referrals are Initiated to appropriate next level of care (e.g. acute care, home health care, hospice, SNF, LTAC, clinics, TCM) in a timely manner and coordinates ordering of medical equipment and supplies for safe discharge plan or ongoing care planning.
- Ensures/maintains plan consensus from patient/family, rehab team and payer.
- Works with staff to facilitate transfer to community or other facilities with appropriate use of transportation resources.
- Evaluates and audits documentation relevant to discharge planning and/or care plan information in the medical record.
- Meets directly with individual team members ensuring patient/family are appropriately assessed for needs with a developed individualized continuing care plan in collaboration with physician and arranges family meetings with patient, family and care team. Collaborates/communicates with internal and external case managers.
- Supervises staff on the screening process with patients within 24 hours of admission for appropriate services and interventions as evidenced by appropriate documentation and services.
- Provides clinical oversight of the documentation of psychosocial, social and discharge needs within 24 hours of patient contact, if appropriate.
- Evaluates data and information to accurately assess level of care as evidenced by documentation and interventions Supervises staff in the creation of plan of care for patient and/or family in collaboration with interdisciplinary team and verifies documentation of the plan on day of weekly team conference while also ensuring case managers escalate: Rehab MD, RN, PT, OT and SLP if ordered are present at team conference, listed on the document and that the document is co-signed by the rehab MD, if indicated.
- Has oversight of staff to ensure all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.
- Seeks consultation, and encourages staff to do the same, from appropriate disciplines/departments as required to expedite care and facilitate discharge.
- Provides guidance to staff to address/resolve any problems impeding diagnostic or treatment progress.
- Escalates issues to next level manager as appropriate.
Requirements For Consideration
Minimum Education - Bachelors in Nursing/Masters in Social Work
Schedule - Fulltime M-F Day Shift
Experience - Three years of experience in case management or relevant nursing experience to include utilization review, discharge planning, outcomes management, transitional planning, assessment, care planning and service implementation. A minimum of two years of direct supervisor/manager experience .
Licensing - BLS from AHA Upon Start and ACM within 12 Months
License- RN Required only for Nursing Case Management who have BSN Degree
Inova Benefits and Perks:
- Health, Vision, and Dental Coverage
- Life Insurance, Short/Long Term Disability
- NEW ! 4 weeks PAID PARENTAL LEAVE
- Retirement: Inova matches dollar for dollar the first 5% of your eligible pay that you contribute to the plan
- Competitive salary: Pay based experience
- Amazing Paid Time Off: Accrue PTO hours on your very first day of work
- Supplemental Plans: Including Auto/Home Insurance discounts, Pet Insurance, Identity Theft Protection
- Additional Benefits: Educational Assistance of up to $5,250/year, Student Loan Refinancing, Adoption Assistance, Child Care Centers, Scholarship Program, Free Parking, Exclusive savings opportunities to in-store events, theme parks, discounts, movie tickets and local offerings and so much more!
See Full List of Benefits Here: 2023 INOVA BENEFITS GUIDE
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